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1. WEGO Health Activist Fertility Webinar Qualification Survey
WEGO Health (http://www.wegohealth.com) is pleased to present "When to See a Reproductive Endocrinologist: 7 Key Factors" with Dr. Glenn Schattman.
This exclusive, live web-event will take place on Wednesday, November 4th. We will be hosting sessions at Noon Eastern, 4PM ET, 6PM ET, and 9PM ET.
Whether you're just beginning your fertility journey, or an experienced Health Activist looking for information to share with your communities, we hope you'll join us on the 4th to learn more about these 7 Key Factors.
Each of these 1-hour sessions will also include time for a live Q&A with Dr. Schattman - so bring your questions!
This program is made possible by one of WEGO Health's sponsors.
To apply, please complete the following 16 question survey - it should take about 5 minutes.
Qualifying Fertility Health Activists will be invited by e-mail to this exclusive event.
1
. What phrases best represent who you are and your contributions to the online health community? (Check all that apply)
What phrases best represent who you are and your contributions to the online health community? (Check all that apply)
I often research health care information for myself or for others.
People often come to me for health related advice.
I review and recommend health care content.
I contribute to multiple online health communities.
I am a health care advocate.
I am an active contributor to the online health community.
2
. Approximately how often do you contribute to the online health community? (Including all forms of media – blogs, message boards, groups, question/answer sites, Twitter, etc.)
Approximately how often do you contribute to the online health community? (Including all forms of media – blogs, message boards, groups, question/answer sites, Twitter, etc.)
Several times a day
Daily
Weekly
Monthly
A few times a year
Never
3
. Including all forms of media, how many different blogs, forums, message boards, online groups, question/answer sites, etc., do you participate in? Count each group separately (for example, Yahoo! HIV Group and Yahoo! Nutrition & Diet Group is 2 groups; Twitter is 1 community, and each blog on which you comment counts as 1).
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
more than 20
Including all forms of media, how many different blogs, forums, message boards, online groups, question/answer sites, etc., do you participate in? Count each group separately (for example, Yahoo! HIV Group and Yahoo! Nutrition & Diet Group is 2 groups; Twitter is 1 community, and each blog on which you comment counts as 1).
4
. On average, how many people are members of the blogs, forums, message boards, online groups, question/answer sites, etc., you belong to?
100 members or fewer
250
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
3250
3500
3750
4000
4250
4500
4750
5000 members or more
10,000 member or more
On average, how many people are members of the blogs, forums, message boards, online groups, question/answer sites, etc., you belong to?
5
. If you write or manage a blog or online journal (Blogger, Myspace, LiveJournal, Carepages websites), please estimate how many people read your blog every month. (NOTE: Your blog can cover any range of topics; it does not need to be only about health.)
I do not have a blog
100 visitors or fewer
250
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
3250
3500
3750
4000
4250
4500
4750
5000 visitors or more
10,000 visitors or more
If you write or manage a blog or online journal (Blogger, Myspace, LiveJournal, Carepages websites), please estimate how many people read your blog every month. (NOTE: Your blog can cover any range of topics; it does not need to be only about health.)
6
. What is the URL of your primary blog? (Optional)
What is the URL of your primary blog? (Optional)
7
. I recommend fertility treatment options to others:
I recommend fertility treatment options to others:
Often
Sometimes
Occasionally
Rarely
Never
8
. How knowledgeable are you about each of these treatments (check one box per product):
Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
Clomid
How knowledgeable are you about each of these treatments (check one box per product): Clomid Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
Bravelle
Bravelle Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
Follistim
Follistim Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
Gonal-f
Gonal-f Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
Menopur
Menopur Don't Know Product
Know of Product
Somewhat Knowledgeable
Knowledgeable
Very Knowledgeable
9
. Based on what you know of these treatments, please give your overall impression (check one box per product):
Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
Clomid
Based on what you know of these treatments, please give your overall impression (check one box per product): Clomid Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
Bravelle
Bravelle Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
Follistim
Follistim Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
Gonal-f
Gonal-f Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
Menopur
Menopur Very Negative
Somewhat Negative
Neutral
Somewhat Positive
Very Positive
Don't Know Product
10
. Based on what you know about these products, would you recommend them to others?
Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
Clomid
Based on what you know about these products, would you recommend them to others? Clomid Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
Bravelle
Bravelle Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
Follistim
Follistim Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
Gonal-f
Gonal-f Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
Menopur
Menopur Would Not Recommend
Unlikely To Recommend
Neutral
Might Recommend
Would Recommend
Don't Know Product
11
. In the online health communities in which you are active, what is the overall perception of the companies and products that treat fertility?
In the online health communities in which you are active, what is the overall perception of the companies and products that treat fertility?
Very Negative
Negative
Neutral
Positive
Very Positive
12
. Where do you participate online (specific health and fertility websites you find most helpful, online communities, etc)?
Where do you participate online (specific health and fertility websites you find most helpful, online communities, etc)?
13
. What questions would you like to ask a physician about fertility? Specifically about seeing a Reproductive Endocrinologist?
What questions would you like to ask a physician about fertility? Specifically about seeing a Reproductive Endocrinologist?
*
14
. We will be holding 3 sessions of "When to See a Reproductive Endocrinologist: 7 Key Factors" on November 4th. Each session will last one hour.
Attendees will need to be online during that hour, and will have the option of listening to the webinar over their computer speakers, or over the phone.
Please indicate which session you would like to attend:
(PLEASE NOTE: ALL TIMES ARE EASTERN TIME)
We will be holding 3 sessions of "When to See a Reproductive Endocrinologist: 7 Key Factors" on November 4th. Each session will last one hour. Attendees will need to be online during that hour, and will have the option of listening to the webinar over their computer speakers, or over the phone. Please indicate which session you would like to attend: (PLEASE NOTE: ALL TIMES ARE EASTERN TIME)
4PM Eastern Time
6PM Eastern Time
9PM Eastern Time
*
15
. Please enter your email address to receive your email invitation to join this exclusive web event:
Please enter your email address to receive your email invitation to join this exclusive web event:
16
. OPTIONAL: Check this box if you would like us to notify you about other programs (including future educational programs), offers and content from WEGO Health:
(We'll never sell your email address and you can unsubscribe from mailings at any time)
OPTIONAL: Check this box if you would like us to notify you about other programs (including future educational programs), offers and content from WEGO Health: (We'll never sell your email address and you can unsubscribe from mailings at any time)
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